Statins are commonly used to lower cholesterol, therefore helping to reduce the risk of cardiovascular disease. But new research finds that US and European cholesterol guidelines differ significantly when it comes to statin use recommendations, meaning many individuals may not be getting the correct treatment.

This is according to a study recently published in the journal JAMA.

Cardiovascular disease (CVD) is a main cause of death in the US. Main risk factors for the condition include high blood pressure, obesity and high cholesterol. Many of these risk factors can be eliminated by lifestyle interventions, but some may need help with medication - such as statins - to help reduce cholesterol.

To determine the best ways to treat patients at risk of CVD, the majority of clinicians follow guidelines set by either the National Cholesterol Education Program expert panel (ATP-III guidelines), the American College of Cardiology/American Heart Association (ACC/AHA) task force and the European Society of Cardiology (ESC).

But according to investigators from Erasmus MC-University Medical Center in the Netherlands, "varying approaches to CVD risk estimation and application of different criteria for therapeutic recommendations would translate into substantial differences in proportions of individuals qualifying for treatment at a population level."

A study finds that different cholesterol guidelines lead to varying statin use recommendations.

With this in mind, the researchers wanted to determine just how these varying guidelines influenced clinical practice in a population of 4,854 Dutch participants, all of whom were aged 55 years or older.

The investigators calculated the participants' 10-year risk for major CVD events, including fatal and nonfatal coronary heart disease (CHD) using the ACC/AHA guideline.

Their risks were also calculated for major CHD events, such as fatal and nonfatal heart attack and CHD mortality - using the ATP-III guideline - and CVD mortality risk was assessed using ESC guideline.

For each guideline, the proportion of individuals who would be recommended statins was calculated.

Differing statin use and CVD overestimation

The researchers found that under the ACC/AHA guideline, statins would be recommended for 96.4% of men and 65.8% of women, while under the ATP-III guideline, statins would be recommended for 52% of men and 35.5% of women. Under the ESC guideline, 66.1% of men and 39.1% of women would be recommended statins.

Using the ACC/AHA guideline, the researchers found that the average predicted risk of major CVD events was 21.5% for men, while actual CVD events came in at 12.7%. For women, predicted risk of major CVD events was 11.6%, compared with actual CVD events at 7.9%. The researchers say that similar overestimations were found using the ATP-III and ESC guidelines.

Commenting on their findings, the researchers say:

"Beyond the need for improving the risk predictions and setting appropriate population-wide thresholds to facilitate better clinical decision making, the large proportion of the population recommended for statin treatment based on new guidelines should be a concerning signal."

"These large numbers point out the need for (1) preventing risk factor aggregation and (2) conveying information to individuals in ways that effectively lower their risk, in an era when cardiovascular disease remains a worldwide public health challenge."

Comparison of Application of the ACC/AHA Guidelines, Adult Treatment Panel III Guidelines, and European Society of Cardiology Guidelines for Cardiovascular Disease Prevention in a European Cohort, doi:10.1001/jama.2014.2632, Maryam Kavousi et al., published in JAMA, 29 March 2014.

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